LAUSR

The definition of resistant hypertension is well known and standardized. However, the definition of refractory hypertension and its epidemiology is less well understood. In 2012, patients followed in a specialty clinic, in University of Alabama, Birmingham, were diagnosed with refractory hypertension if blood pressure (BP) remained uncontrolled after ≥3 visits to a hypertension clinic within a minimum 6-month follow-up period.1 In this retrospective study, only about 10% of the patients with resistant hypertension had refractory hypertension. In 2020, from the same specialty clinic at University of Alabama, Birmingham, refractory hypertension was diagnosed in patients who needed ≥5 antihypertensive medications including chlorthalidone and a MRA (mineralocorticoid receptor antagonist) and had uncontrolled BP after ≥3 visits to a hypertension clinic but without specification of a follow-up period.2 Nearly half the patients who were thought to have refractory hypertension, were either not taking their medications or had hypertension controlled on 24-hour ambulatory BP monitoring. Although, the definition of refractory hypertension changed, the investigators concluded that the disease is real but rare.